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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

When blood is released into the tissues of the lower extremities, it may drift downward under the influence of the force of gravity to produce the influence of the force of gravity to produce pain, edema, redness and heat. A crescent shaped ecchymosis may appear around the malleoli. The relationship between cause and effect may be obscured by a time interval of up to four weeks before conclusive signs are seen. Early differentiation of this condition from that of phlebitis and deep venous thrombosis is necessary. Such differentiation prevents inappropriate and potentially dangerous anticoagulation as well as the disastrous consequences of untreated edema of the legs. With prompt, appropriate treatment, complete recovery can be expected. If treatment is delayed, permanent damage to the leg can result.
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PMID:Drifting hematomas. 41 23

In two studies 267 consecutive patients with suspected venous thrombosis were examined 125I-fibrinogen uptake test at phebography. In 161 patients meglumine metrizoate (Isopaque Cerebral) and in 106 patients metrizamide (Amipaque) was used as contrast medium. The quality of the examinations was equal in the two groups. During the examinations most of the patients examined with meglumine metrizoate had symptoms from the calf described as a cramp-like pain. Only few of the patients examined with metrizamide had such symptoms. In the two groups 47 patients examined with meglumine metrizoate and 41 examined with metrizamide had normal phlebography as well as initially normal 125I-fibrinogen uptake test. After phlebography, 29 of the patients in the first group had a significant rise in fibrinogen uptake while such a rise was not found in patients from the second group. Rephlebography showed fresh deep vein thrombosis in 7 out of 9 patients examined with meglumine metrizoate indicating that thrombosis could be provoked in as many as about half the patients with this high osmolar contrast medium. We have now used metrizamide in about 400 patients without any side-effects.
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PMID:Side-effects at phlebography with ionized and non-ionized contrast medium. 49 20

48 patients with acute deep venous thrombosis of the lower limbs were treated with sodium heparin. In 23 patients heparin was injected subcutaneously (s.c.) twice a day and in 25 patients heparin was given by continuous intravenous perfusion (i.v.). Pain and edema disappeared after 8.7 days (s.c.) and 11.7 days (i.v.) respectively. One non fatal pulmonary embolism occurred in each group. A second venography was performed in 24 patients after 7 days of treatment and revealed no difference between the two groups. As judged by repeated thrombin time determination, anticoagulation was ineffective on at least one day in 39% of patients treated subcutaneously and in 60% of patients treated intravenously. The two pulmonary embolisms occurred in patients with ineffective anticoagulation. It is concluded that heparin may be used either intravenously or subcutaneously in the treatment of acute deep venous thrombosis. Thromboembolic complications occurred with both methods of treatment when anticoagulation was ineffective.
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PMID:[Heparin treatment. Comparison between intravenous and subcutaneous administration]. 50 73

Obesity has been considered as a high risk factor in the development of thromboembolism. To test the validity of this hypothesis, the records of 564 morbidly obese patients who underwent gastric bypass for control of their obesity were reviewed. Four patients, 0.7 per cent, had proved fatal pulmonary emboli and three demonstrated detectable, but not fatal, embolization. Fifty-seven patients were studied prospectively with Doppler examinations of the lower extremities, and only one patient had a transient abnormality of venous thrombosis of the calf, which proved to be associated with a nonfatal pulmonary embolus. The morbidly obese patients are not at high risk from thromboembolism, and the prophylactic use of low dose heparin, which may increase known wound morbidity, is discouraged. Doppler ultrasound of the lower extremities, however, has proved usefulness to differentiate deep venous thrombosis of the lower extremity from other causes of pain in the leg of the morbidly obese.
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PMID:Venous thromboembolism in the morbidly obese. 66 11

Five hundred and sixty-four patients undergoing abdominal surgery, who were carefully assessed at the time of operation for evidence of venous thrombosis, have been followed up to determine the incidence of leg symptoms, varicose veins and post-thrombotic syndrome. Patients are frequently troubled by pain, swelling and phlebitis, which can persist for up to a year after operation. New varicose veins developed by 1 year in 20 per cent of patients. These occurred with increased frequency in patients who also developed a deep vein thrombosis, but they were also seen in patients who showed no clinical or isotopic evidence of thrombosis. The post-thrombotic syndrome was present in 26 patients by 3 years after the operation; half of these patients had suffered the syndrome before the definitive operation. Assessment of the long term effects of venous thrombosis must be carried out against the background of similar effects seen in patients without thrombi, and the development of the post-thrombotic syndrome may best be considered as the summation of a number of incidents, overt or occult, occurring throughout a lifetime.
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PMID:The long term sequelae of deep vein thrombosis. 70 77

The reliability of the diagnosis made on the basis of symptoms of deep venous thrombosis and the development of a post-thrombotic state were studied in 53 patients. Pain in the leg was present in 93% and swelling in 82% of the series, both figures are considerably higher than those reported before. The clinical diagnosis was correct in 74% of cases. The post-thrombotic state developed with unexpected rapidity: after one to three years 87% already had symptoms and/or signs of venous insufficiency, and after eight years at the latest all patients had such symptoms and/or signs.
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PMID:Clinical diagnosis and prognosis of deep venous thrombosis. 113 41

A 16 year old teenager with chest pain came to the emergency room at Children's Hospital in Charleston, South Carolina. Her sharp, constant midsternal pain and breathing difficulties began the morning of admission. 1 week before admission, she experienced a similar but less intense pain which resolved spontaneously. She was taking low-dose, triphasic oral contraceptives (OCs) as treatment for severe dysmenorrhea and dysfunctional uterine bleeding. She had no family history of elevated lipids, blood or clotting disorders, and cardiovascular disease. She did not smoke. She was obese (137.3 kg). She had elevated blood pressure (147/33 mm Hg), a high low-density lipoprotein count (140 mg/dL), and a high total cholesterol count (237 mg/dL). Her tender right calf was larger than the left calf. She had decreased perfusion of the entire left lung and right lower lobe. A pulmonary angiogram revealed emboli, and ultrasound of the legs revealed a thrombus behind the right knee. The physicians discontinued the OCs. They administered 2 anticoagulants--intravenous heparin followed by oral sodium warfarin for 6 months. Her respiratory distress ended within several days. Her right calf was no longer tender after 1 week. The physicians discharged her on a low-cholesterol, low-fat diet. They suggested she reduce her weight and exercise more often. She did not experience another venous thrombosis or pulmonary embolus. It appeared that the OCs contributed to her thromboembolism; yet, she did lead a sedentary lifestyle and was considerably overweight. Even though thromboembolism is rare in adolescents with no underlying predisposition for cardiovascular disease and who do not smoke, physicians should watch for sizeable changes in blood pressure, lipids, and cholesterol level as well as symptoms of deep venous thrombosis and cardiovascular disease.
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PMID:Pulmonary embolus in an adolescent on oral contraceptives. 129 Jul 74

The efficacy of two treatment protocols with a low molecular weight heparin used for the prevention of post-operative deep vein thrombosis was compared in 40 patients undergoing hip replacement surgery. The aim was to assess whether the different timing--2 hours before (Group A, 19 patients) or 2 hours after (Group B, 21 patients) the surgical operation--of the first dose administered (15,000 aXaU) of a therapeutic cycle of 7 days could affect the results, both with respect to the preventive efficacy and to the risk of haemorrhage often connected with antithrombotic therapy. The results showed that the incidence of deep vein thrombosis was very similar and extremely low in the two groups, only 1 patient in each group having a positive diagnosis on phlebography. The effectiveness of a single daily dose of 15,000 aXaU in orthopaedic surgery was also confirmed. This dose guaranteed effective prophylaxis against the onset of deep vein thrombosis and did not appear to have any local side-effects (such as burning or pain at the site of injection) which could diminish patient compliance.
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PMID:Prevention of deep vein thrombosis in orthopaedic surgery. Comparison of two different treatment protocols with low molecular weight heparin ('Fluxum'). 131 59

Twenty patients with complications of drug addiction were admitted to the Department of Vascular Surgery of the Santa Catarina University Hospital, from January 1986 to September 1990. Most of these patients were male, aged between 20 and 35 years. The most common drug used was propoxiphene, followed by cocaine. Swelling, ulcers and pain in the inferior extremities were the most common signs and symptoms. Six patients presented deep venous thrombosis, four had acute lymphangitis, all of them in the lower limbs. Five patients had acute arterial occlusions, one presented common femoral artery mycotic aneurysm and another had a false aneurysm of the superficial femoral artery. Venous and lymphatic complications were clinically treated with antibiotics, heparin and local care. Six patients were submitted to surgical procedures. One was treated by aneurysmectomy and vascular reconstruction, another with aneurysmectomy and arterial ligation. On one patient forearm fasciotomy was performed. Two amputations and one drainage of abscess were carried out.
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PMID:[Vascular complications in intravenous drug addicts]. 134 Mar 77

The complex embryologic development of the vascular system often results in a myriad of clinically relevant anomalies. It has been stated that the classic anatomic venous pattern in the lower extremity is found in only 16 percent of patients. Previous studies on this topic are limited to isolated venous dissections or phlebography that lack complete anatomic detail. The recent introduction of high resolution duplex scanners for the assessment of veins of the lower extremity provides a unique opportunity to determine the incidence of anatomic variation. The current prospective study was done to identify venous or arterial anomalies apparent during routine duplex scanning of the lower extremity performed to rule out deep venous thrombosis (DVT). Limbs that had evidence of acute or chronic extensive DVT were excluded. Of 1,600 consecutive extremity scans, 946 extremities (59 percent) had no evidence of DVT. Of these, there were 43 patients with 64 anomalies in 57 extremities. The mean age of the group was 53.4 years. There were 24 women (55.8 percent) and 19 men (44.2 percent). There were 59 (92.2 percent) venous and five (7.8 percent) arterial anomalies. Duplication of the superficial femoral vein was the most common anomaly noted. Duplication of the deep femoral and popliteal vein was also noted. Unilateral anomalies were more common than bilateral anomalies, namely 67.4 versus 32.6 percent, respectively. Pain and swelling, common complaints in the patients with an anomaly, were noted in 71.4 and 45.7 percent, respectively. The frequency of deep venous anomalies of the lower extremities may be less than previously reported. Knowledge concerning the incidence and distribution of venous anomalies may lead to improved assessment and treatment of venous disease.
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PMID:Venous and arterial anomalies of the lower extremities diagnosed by duplex scanning. 141 86


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